Provider Demographics
NPI:1679992473
Name:MCDERMOTT, KAREN ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5746
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93456
Mailing Address - Country:US
Mailing Address - Phone:805-868-6075
Mailing Address - Fax:805-922-0089
Practice Address - Street 1:201 S MILLER STREET SUITE 103
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454
Practice Address - Country:US
Practice Address - Phone:805-868-6075
Practice Address - Fax:805-922-0089
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT41639106H00000X
CAMFC41639106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty